Desenredando los nudos en cirugía: creando maestría con un simulador práctico en casa / Untangling the knots in surgery: Creating mastery with a practical at-home simulator

Introducción. Anudar es una de las habilidades quirúrgicas esenciales y de su correcta ejecución dependen procesos de vital importancia. La adquisición de estas competencias requiere trabajo motor, entornos amigables y realistas. Una estrategia para facilitar el aprendizaje de la técnica de anudado es generar instrumentos de simulación accesibles. Métodos. Se presenta un simulador de nudos quirúrgicos, construido con materiales de bajo costo y asequibles para la población en general, con un presupuesto de aproximadamente $5.000 COP (US$ 1,23). Resultados. Se desarrolló un simulador de nudos quirúrgicos que, al fijarse a la extremidad inferior desde una posición sentada, proporciona una superficie estable para llevar a cabo la práctica de anudado de manera efectiva. Conclusión. La cirugía moderna considera la seguridad del paciente como la principal prioridad, por lo que ya no es apropiado adoptar un método de formación de "ver uno, hacer uno, enseñar uno". Es la práctica constante mediante simuladores, el método más adecuado. Este trabajo presenta una alternativa de aprendizaje ininterrumpido de las técnicas quirúrgicas relacionadas con los nudos.

Introduction. Knotting is one of the essential surgical skills and vitally important processes that depends on its correct execution. The acquisition of these skills requires motor work, friendly and realistic environments. A strategy to facilitate learning the knotting technique is to generate accessible simulation instruments. Methods. A surgical knot simulator is presented, built with low-budget materials and affordable for the general population, with a budget of approximately $5,000 COP (US$ 1.23). Results. A surgical knot simulator has been developed in a way that, when attached to the thigh of a lower extremity from a seated position, provides a stable surface to effectively perform knot tying practice. Conclusion. Modern surgery considers patient safety as the top priority, so it is no longer appropriate to adopt a "see one, do one, teach one" training method. Constant practice using simulators is the most appropriate method. This work presents an alternative for uninterrupted learning of surgical techniques related to knots.

Development of a low-cost simulator for training in hemorrhoidal ligation

Introduction: Rubber band ligation is a minimally invasive outpatient hemorrhoid treatment with low cost, low complication rates, and rapid realization. It is performed with the aid of an anoscope and uses a rubber ring that surrounds the hemorrhoidal nipple, causing compression of the vascular structures of the tissue, leading to necrosis and remission of the hemorrhoid. No device for training this essential procedure for treating this pathology has been identified in the literature. Therefore, we aim to develop a low-cost simulator for training hemorrhoidal rubber ligation. Methods: The model was constructed using PVC pipe wrapped in neoprene fabric. Hemorrhoidal nipples and the pectineal line were also simulated using fabric and sewing threads. The procedure is performed with conventional anoscope and ligature forceps. Conclusion: The device in question is a low-cost simulation model designed to train the skills required to perform a rubber band ligation and review the basic anatomy of the anal canal during anoscopy. Given these qualities, the model can be used for academic training due to its low cost and simplicity of application. (AU)

Self-medication among inhabitants of Yaounde, Cameroon: Pull and push factors

The rampant practice of self-medication is indicative of very strong existing push and pulls factors. These factors could be economic, social or systemic. Despite having some beneficial effects, selfmedication has life-threatening consequences. This study was aimed to determine the factors which push users to medicine sources or factors at the sources which pull users. A pre-validated questionnaire was administered to participants. Data were collected and analyzed using Microsoft Excel and the results expressed as frequencies and percentages. From the total of 650 respondents, poverty was found to be the major push factor for 360 participants (55.39%), followed by unprofessionalism, friends' advice, previous use of medicine, lack of time, and poor price regulation as others. Low cost of medicines was found to pull 402 (61.8%) users to sources of medicines for self-medication. More than 300 of the respondents found easy access to medicine and advertising as strong pull factors. Other important pull factors include quick and time-saving, proliferation of medicine vendors, hospital crowds, and inadequate prescription checks at sources of medication. Poverty is a major push factor for self-medication, further compounded by quick access to illicit sources of medication. Consequently, users get pulled to cheaper sources, which unfortunately sell poor quality medicines, lack the expertise, or do not check prescription. Price control is required to ensure that quality medicines are accessible to users. Imposing physician prescription at all medicine sales points is a crucial step to fight the deleterious consequences of self-medication. Although self-medication has some positive elements, its practice needs to be put under control to avoid grappling with long term health complications.

Atuação da psicologia em unidade neonatal no contexto da pandemia da covid-19 / The work of psychology in a neonatal unit in the covid-19 pandemic / Actuación de la psicología en una unidad neonatal en el contexto de la pandemia de la covid-19

A pandemia de covid-19 provocou intensas mudanças no contexto do cuidado neonatal, exigindo dos profissionais de saúde a reformulação de práticas e o desenvolvimento de novas estratégias para a manutenção da atenção integral e humanizada ao recém-nascido. O objetivo deste artigo é relatar a atuação da Psicologia nas Unidades Neonatais de um hospital público de Fortaleza (CE), Brasil, durante o período de distanciamento físico da pandemia de covid-19. Trata-se de estudo descritivo, do tipo relato de experiência, que ocorreu no período de março a agosto de 2020. No contexto pandêmico, o serviço de Psicologia desenvolveu novas condutas assistenciais para atender às demandas emergentes do momento, como: atendimento remoto; registro e envio on-line de imagens do recém-nascido a seus familiares; visitas virtuais; e reprodução de mensagens de áudio da família para o neonato. Apesar dos desafios encontrados, as ações contribuíram para a manutenção do cuidado centrado no recém-nascido e sua família, o que demonstra a potencialidade do fazer psicológico.(AU)

The COVID-19 pandemic brought intense changes to neonatal care and required health professionals to reformulate practices and develop new strategies to ensure comprehensive and humanized care for newborn. This study aims to report the experience of the Psychology Service in the Neonatal Units of a public hospital in Fortaleza, in the state of Ceará, Brazil, during the social distancing period of the COVID-19 pandemic. This descriptive experience report study was conducted from March to August 2020. During the pandemic, the Psychology Service developed new care practices to meet the emerging demands of that moment, such as remote care, recordings and online submission of newborns' pictures and video images for their family, virtual tours, and reproduction of family audio messages for the newborns. Despite the challenges, the actions contributed to the maintenance of a care that is centered on the newborns and their families, which shows the potential of psychological practices.(AU)

La pandemia de la COVID-19 ha traído cambios intensos en el contexto de la atención neonatal, que requieren de los profesionales de la salud una reformulación de sus prácticas y el desarrollo de nuevas estrategias para asegurar una atención integral y humanizada al recién nacido. El objetivo de este artículo es reportar la experiencia del Servicio de Psicología en las Unidades Neonatales de un hospital público de Fortaleza, en Ceará, Brasil, durante el periodo de distanciamiento físico en la pandemia de la COVID-19. Se trata de un estudio descriptivo, un reporte de experiencia, que se llevó a cabo de marzo a agosto de 2020. En el contexto pandémico, el servicio de Psicología desarrolló nuevas conductas asistenciales para atender a las demandas emergentes del momento, tales como: atención remota; grabación y envío em línea de imágenes del recién nacido; visitas virtuales; y reproducción de mensajes de audio de la familia para el recién nacido. A pesar de los desafíos encontrados, las acciones contribuyeron al mantenimiento de la atención centrada en el recién nacido y su familia, lo que demuestra el potencial de la práctica psicológica.(AU)

Low-cost suture simulator to gain basic surgical skills

ABSTRACT Purpose: To introduce a new low-cost simulation model for training basic surgical skills. Methods: The training model was made from a mixture of 20 g of acetic silicone with 11 g of maize starch. Validation consisted of serial training sessions, evaluating the mean pre- and post-training time and the mean final score according to the global rating scale. Results: A decrease in the time required to perform the sutures was observed, comparing the average post and pre-training time of each training day, with a significant correlation between the order of training and the time for performing the simulation. Conclusions: The presented model proved to be capable of simulating the basic suture training skills. It is easy to make, has low cost, and can be easily reproduced in educational institutions.

Desenvolvimento de sistema de rastreabilidade automatizada de baixo custo para centro de material e esterilização / Development of a low-cost automated traceability system for the Sterile Processing Department / Desarrollo de un sistema de trazabilidad automatizado de bajo costo para material y centro de esterilización

Objetivo: Desenvolver um sistema de baixo custo que possibilite a automatização do processo de rastreabilidade em um centro de material e este-rilização. Método: Trata-se de pesquisa aplicada, com foco em uma produção tecnológica (prototipação), visando ao desenvolvimento de um sistema auto-matizado de rastreabilidade para centro de material e esterilização. O desenvolvimento do sistema seguiu o modelo das fases do ciclo de vida de um software para o desenvolvimento de protótipos, utilizando-se para sua construção funcionalidades existentes no software Microsoft Excel 2013©. Resultados: Seguindo as fases do modelo proposto, e de acordo com as diretrizes dos órgãos competentes, desenvolveu-se um sistema de rastreabilidade automatizada, com visual simples e intuitivo, capaz de executar funções: de registro, por meio de código de barras; de acesso às informações dos processos executados no centro de material e esterilização, por meio de planilha alimentada automaticamente; de segurança, com login e senha individuais. Conclusão: Este tra-balho cumpriu seu objetivo de propor um sistema de rastreabilidade de baixo custo que atendesse às necessidades do centro de material e esterilização, necessidades que compreendem não somente as normas impostas por órgãos reguladores, mas também a automatização do processo de rastreabilidade.

Objective: To develop a low-cost system that enables the automation of the traceability process in a Sterile Processing Department. Method: This is an applied research, focusing on technological production (prototyping), aiming at the development of an automated traceability system for the Sterile Processing Department. The system was developed following the model of the software life cycle for developing prototypes, making use of existing func-tionalities in the Microsoft Excel 2013© software. Results: Following the phases of the proposed model, and in accordance with the guidelines of competent bodies, an automated traceability system was developed, with a simple and intuitive design, capable of performing the following functions: registration, by using a barcode; access to information on the processes performed at the Sterile Processing Department, by an automatically fed spreadsheet; and security, with individual login and password. Conclusions: This study fulfilled its objective of proposing a low-cost traceability system that would meet the needs of the Sterile Processing Department, which included not only the rules imposed by regulatory bodies, but also the automation of the traceability process.

Objetivo: Desarrollar un sistema de bajo costo que permita la automatización del proceso de trazabilidad en un CME. Método: Se trata de investigación aplicada, con foco en la producción tecnológica (prototipado), con el objetivo de desarrollar un sistema de trazabilidad automatizado para CME. El desarrollo del sistema siguió el modelo de las fases del ciclo de vida de un software para el desarrollo de prototipos, utilizando para su construcción funcionalidades existentes en el software Microsoft Excel 2013©, en su versión de escritorio. Resultados: Siguiendo las fases del modelo propuesto, y de acuerdo con las directrices de los órganos competentes, se desarrolló un sistema de trazabilidad automatizado, de apariencia sencilla e intuitiva, capaz de realizar: funciones de registro, por medio de un código de barras; acceder a la información de los procesos ejecutados en el CME, a través de una hoja de cálculo alimentada automáticamente; y seguridad, con usuario y contraseña individual. Conclusión: Este trabajo cumplió con su objetivo de proponer un sistema de trazabilidad de bajo costo que satisficiera las necesidades de los CME, necesidades que incluyen no solo las normas impuestas por los organismos reguladores, sino también la automatización del proceso de trazabilidad.

Low-cost colonoscopic simulator and colonoscope to train basic skills in colonoscopy during undergraduate studies

Objective: To develop a low-cost simulator model and a colonoscope with materials that are easily accessible to offer training on colonoscopy skills during undergraduate studies. Since this is the procedure of choice for colorectal cancer screening, the general practitioner must be able to recognize its main indications, preparation, and complications. Methods: Using materials such as a mannequin, a vehicle inspection camera, a conduit, polyvinyl chloride (PVC) pipe, acrylic, wood, and red paint, we built a simulator and a 150-cm long and 20-to-25-mm thick colonoscope. The colonoscope's handle and handhold were made of acrylic, the colonoscope's mobile end was made with articulated PVC rings, and the up and down movements were performed according to the traction of the steel cables. The camera attached to its distal end enables connection to a smartphone to view the image. In the simulator, the conduit was inserted into the mannequin to simulate the curvatures of the colon. Red spray paint was used to simulate the staining of the colonic mucosa in the inner region of the mannequin and the adventitial layer in the outer region. Results: We were able to build a simulator and a colonoscope with a total amount of R $ 182.82 (roughly US$ 36.50). Both were tested and proved to be useful in the acquisition of psychomotor and cognitive skills in colonoscopy. Conclusion The simulator and colonoscope developed by us are cost-effective, useful in the acquisition of psychomotor and cognitive skills in colonoscopy, and can facilitate the structuring of a training program for undergraduate students. (AU)

Medicina personalizada en urología: Perspectiva desde un sistema de salud con escasez / Personalized Medicine in Urology: Perspective from a Sparse Health System

La medicina personalizada (MP) trae la promesa del cuidado individual a través de la identificación de variaciones genéticas que permitan determinar la predisposición ante una enfermedad, ofreciendo una prevención oportuna y específica, o adaptando las estrategias terapéuticas de manera particular.[1] [2] Su esencia es la integración de la investigación biomédica y la información clínica,[3] [4] con la esperanza de reducir el gasto en salud y la garantía de acceso equitativo a los ciudadanos.[4] La rapidez y bajo costo en la secuenciación del genoma ha permitido su implementación en la práctica clínica.[1] En urología estos avances han facilitado una mejor comprensión de los subtipos histológicos de las neoplasias del tracto genitourinario, facilitando el uso de tratamientos específicos y un seguimiento más oportuno.[2] [5] [6] Sin embargo, su aplicación en la identificación de biomarcadores no ha sido completamente determinada

Personalized medicine (PM) brings the promise of individualized care through the identification of genetic variations that allow determining the predisposition to a disease, offering timely and specific prevention, or adapting therapeutic strategies in a particular way.[1] [2] Its essence is the integration of biomedical research and clinical information,[3] [4] with the hope of reducing health spending and guaranteeing equitable access to citizens.[4] The speed and low cost of genome sequencing has allowed its implementation in clinical practice.[1] In urology, these advances have facilitated a better understanding of the histological subtypes of histological subtypes of neoplasms in urology. The speed and low cost of genome sequencing has allowed its implementation in clinical practice.[1] In urology these advances have facilitated a better understanding of the histological subtypes of neoplasms of the genitourinary tract, facilitating the use of specific treatments and more timely follow-up.[2] [5] [6] However, its application in the identification of biomarkers has not been fully determined.

Use of microalgal biomass as functional ingredient for preparation of cereal based extrudates: impact of processing on amino acid concentrations and colour degradation kinetics

Abstract Suitability of developing Spirulina incorporated cereal based low cost nutritious extrudates was analysed against extrusion processing parameters. Most significant extrusion processing parameters considered for present study were feed moisture (20-25%), die temperature (100-120 °C) and screw speed (50-100 rpm). Different extrusion conditions were used to obtain most acceptable rice: Spirulina blend extrudates. In present study before extrusion processing different additives (citric acid and sodium bicarbonate) were added in rice: Spirulina blend and checked its effect on colour degradation kinetics at varied packaging and storage conditions. Higher screw speed (100 rpm) indicating less residence time of feed material inside the barrel resulted in higher colour retention of rice: Spirulina (97:03) blend extrudates. Kinetics for rice: Spirulina (97:03) blend extrudates indicates faster rate of colour degradation in terms of lightness (half-life of 4 days) when packed in metalized polyethylene at 50°C with 65% relative humidity. Increased concentration of Spirulina (1-3%) in raw formulations resulted in increase in concentration of all amino acids. Impact of extrusion processing has shown non-significant (p ≤ 0.05) effect on amino acid concentrations of rice: Spirulina blend extrudates. Also, all the spirulina added samples showed good consumer acceptability with the score of 6.7

Shoulder Arthroscopy - Creating an Affordable Training Model / Artroscopia do ombro - Criação de um modelo de treinamento acessível

Abstract The present study created a cheap (below US$ 100) shoulder arthroscopy training model, affordable for the practical education of medical students and residents. The model was created using a polyvinyl chloride (PVC) knee joint pipe (150 mm in diameter and 90 degrees in inclination) and a synthetic shoulder model. The parts were arranged to simulate a lateral recumbency with the upper limb in traction, which is the frequent positioning during arthroscopies. Colored dots on the glenoid and a partial rotator cuff model on the upper portion of the scapula were placed to assist training. This inexpensive, easy-to-make model for shoulder arthroscopy can aid surgical training.

Resumo O objetivo do presente trabalho é criar um modelo de treinamento em artroscopia de ombro de baixo custo abaixo de 100 dólares, tornando-o acessível à capacitação prática de estudantes de medicina e residentes. O modelo foi criado utilizando um cano de PVC de 150 mm de diâmetro em 90 graus e um modelo de ombro sintético. O posicionamento das peças foi disposto de forma a simular a posição de decúbito lateral com membro superior em tração, frequente nas artroscopias. Para auxiliar no treinamento, foram demarcados pontos coloridos na glenóide e foi confeccionado um modelo de parte do manguito rotador na porção superior da escápula. Foi possível confeccionar um modelo para treinamento de artroscopia do ombro com um valor abaixo de 100 dólares, de fácil manufatura, que pode ser um auxiliar no treinamento de cirurgiões.

A Simple and Low-Cost, but Naturalistic Method for Introducing Students to Action Potentials

Abstract Current trends in science education recommend the complementary use of virtual and hands-on methods of teaching. In neurobiology, for instance, there is a plethora of virtual laboratories and simulators that can be readily combined with traditional physical labs. Unfortunately, physical laboratories are almost unaffordable for many institutions due to the high cost of equipment. In this paper, we present a simple and low-cost in vivo method for demonstrating some of the basic biophysical properties of neural action potentials. The method involves the following steps: a) dissection of the ventral nerve cord of earthworm; b) electrical stimulation; c) amplification and visualization of the medial and lateral giant fibers' action potentials; and d) recording. The system showed stability, expected amplification, high signal-to-noise ratio, and an estimated total cost of US$ 5.662. We provide guidelines for assembling the system and discus its utility as a teaching alternative for low budget institutions.

Sagitectomía Endoscópica: Planeamiento Quirúrgico con Modelos de Simulación de Bajo Costo / Endoscopic Sagitectomy: Surgical Planning with Low-Cost Simulation Models

Objetivos: El objetivo es presentar un caso de sagitectomía asistida por endoscopía y su planificación y entrenamiento prequirúrgico con modelos de simulación de bajo costo. Métodos: Se procesó una tomografía de un paciente con escafocefalia, a partir de la cual se realizó una impresión 3D de un cráneo sin huesos parietales. Se completó el modelo de simulación con materiales de bajo costo para simular los tejidos blandos y hueso. Se realizó el entrenamiento con un endoscopio de 30º. Luego del entrenamiento, se realizó una cirugía en un paciente de 2 meses de edad que presentaba una escafocefalia. Resultados: Se creó un modelo de simulación de bajo costo (aproximadamente 20 US$) para el entrenamiento de sagitectomía asistida por endoscopía. Se realizó la cirugía en un paciente, sin complicaciones quirúrgicas ni posoperatorias. Conclusión: El entrenamiento con simuladores de bajo costo permite planificar una sagitectomía asistida por endoscopía, disminuyendo los errores y los tiempos de la curva de aprendizaje.

Atividade física para pessoas idosas realizada em espaços públicos: uma revisão integrativa / Physical activity for elderly persons done in public spaces: an integrating review / Actividad física para personas idosas realizada en espacios públicos: una revisión integrativa

Objetivo: identificar as evidências disponíveis na literatura científica publicada sobre atividade física para pessoas idosas realizada em espaços públicos. Método: revisão integrativa, mediante 21 artigos na BDENF, Index Psicologia, LILACS e MEDLINE no período de 2008 a 2018. Emergiram as categorias: Benefícios da prática de atividade física realizada por idosos e Dificuldades de pessoas idosas para a realização de atividade física em espaços públicos. Resultados: pessoas idosas praticantes de atividade física em academias e em praças apresentaram melhor desempenho em teste de aptidão física e melhor capacidade funcional do que os idosos sedentários. Dentre as principais dificuldades encontradas pelos idosos: problemas de saúde e inviabilização de espaços públicos adequados para a prática de atividade física. Conclusão: mostrou-se a relevância da atividade física para idosos realizada em espaços públicos, a partir dos benefícios de sua realização e por se tratar de uma atividade de baixo custo, no entanto, ainda é preciso a implementação de ações e estratégias para diminuir as dificuldades encontradas pelos idosos para a realização da atividade física em espaços públicos

Objective: to analyze the scientific production on physical activity for the elderly in public spaces in online journals. Method: integrative review, through 21 articles in the BDENF, Index Psychology, LILACS and MEDLINE in the period from 2008 to 2018. The following categories emerged: Benefits of the practice of physical activity performed by the elderly; and Difficulties of elderly people to perform physical activity in public spaces. Results: elderly people practicing physical activity in gymnasiums and in squares presented better performance in physical fitness test and better functional capacity than the sedentary elderly. Among the main difficulties encountered by the elderly: health problems and unfeasibility of public spaces suitable for the practice of physical activity. Conclusion: it was shown the relevance of physical activity for the elderly in public spaces, from the benefits of its accomplishment and because it is a low cost activity, however, it is still necessary to implement actions and strategies to reduce difficulties encountered by the elderly to perform physical activity in public spaces

Objetivo: analizar la producción científica sobre actividad física para personas ancianas realizada en espacios públicos en periódicos en línea. Método: revisión integrativa, mediante 21 artículos en la BDENF, Index Psicología, LILACS y MEDLINE en el período de 2008 a 2018.Resultados: personas mayores practicantes de actividad física en gimnasios y en plazas presentaron mejor desempeño en prueba de aptitud física y mejor capacidad funcional que los ancianos sedentarios. Entre las principales dificultades encontradas por los ancianos: problemas de salud e inviabilización de espacios públicos adecuados para la práctica de actividad física. Conclusión: se mostró la relevancia de la actividad física para ancianos realizada en espacios públicos, a partir de los beneficios de su realización y por tratarse de una actividad de bajo costo, sin embargo, todavía es necesaria la implementación de acciones y estrategias para disminuir las dificultades encontradas por los ancianos para la realización de la actividad física en espacios públicos

Metodologias ativas no cateterismo periférico venoso: desenvolvimento de habilidades com simulador de baixo custo / Active methodologies in peripheral venous catheterization: Skills development with a low-cost simulator

RESUMO Objetivo Conhecer a percepção de estudantes de enfermagem sobre a contribuição do uso do simulador de baixo custo no desenvolvimento de habilidades técnicas para o cateterismo periférico venoso. Método Estudo descritivo de abordagem qualitativa, realizado em universidade pública do sul do Brasil com 25 estudantes de enfermagem. Os dados foram coletados em 2019, por meio de questionário acerca do cateterismo periférico venoso, desenvolvido com apoio de simulador de baixo custo. Para análise, seguiu-se a proposta operativa de Minayo. Resultados A partir dos dados, surgiram duas categorias. 1) Desenvolvimento de habilidades para cateterismo periférico venoso: os estudantes apontaram que o uso do simulador possibilita compreender cada etapa do procedimento e identificar onde precisam aperfeiçoar a técnica, preparando-os para o contato com o paciente. 2) Dificuldades encontradas na utilização do simulador de baixo custo. Os estudantes destacaram a baixa fidelidade do simulador e a limitação do treinamento por simulação sem comunicação. Conclusões e implicações para a prática Os estudantes percebem o simulador de baixo custo como uma relevante ferramenta para o desenvolvimento de habilidades do cateterismo periférico venoso, sugerem seu aperfeiçoamento para aumentar a fidelidade e a incorporação da comunicação no momento da punção para o maior realismo da experiência simulada.

ABSTRACT Objective To investigate nursing students' perception on the contribution of using a low-cost simulator in the development of technical skills for peripheral venous catheterization. Method A qualitative and descriptive study carried out in a public university of southern Brazil. Data was collected from 25 nursing students in 2019 by means of a questionnaire about peripheral venous catheterization, developed with the support of a low-cost simulator. Data was analyzed using Minayo's operative proposal. Results Two categories emerged from the data. 1) Skills development for peripheral venous catheterization: the students pointed out that the use of the simulator makes it possible to understand each stage of the procedure and to identify where they need to improve the technique, preparing them for contact with the patient. 2) Difficulties encountered in using the low-cost simulator. The students highlighted the low fidelity of the simulator and the limitation of the training by simulation without communication. Conclusions and implications for practice The students perceive the low-cost simulator as a relevant tool for the development of venipuncture skills and they suggest its improvement to increase fidelity, as well as the incorporation of communication at the moment of puncture for greater realism of the simulated experience.

New infusion device for use in acquisition of images during endovascular procedures: an experimental model / Novo dispositivo de infusão para a aquisição de imagens durante procedimentos endovasculares: modelo experimental

Abstract Background The contrast power injector (CPI) is the gold standard method for injecting contrast with the pressure and flow needed to generate a satisfactory images during endovascular procedures, but it is an expensive tool, narrowing its wide-scale applications. One alternative is the manual injection (MI) method, but this does not generate the pressure required for adequate visualization of anatomy. It is therefore imperative to create an alternative low-cost method that is capable of producing high quality images. Objectives To compare the injection parameters of a new mechanical device (Hand-Crank) created in a university hospital with the MI method and with the contrast power injector's ideal values. Methods A circulation phantom was constructed to simulate the pressure in the aorto-iliac territory and the injection parameters of the two methods were compared in a laboratory setting. Student's t test and the Mann-Whitney test were used for statistical analysis. Three vascular surgery residents (the authors) performed the injections (each performed 9 tests using conventional manual injection and 9 tests using the Hand-Crank, totaling 54 injections). Results There were statistical differences between the two methods (p<0.05) in total volume injected until maximum pressure was attained, pressure variation, maximum pressure, total injection time, and time to reach the maximum pressure. Conclusions The Hand-Crank can achieve higher maximum pressure, higher average flow, and lower injection time than the manual method. It is a simple, low-cost, and effective tool for enhancing injection parameters in an experimental setup. It could help to produce higher quality images in a clinical scenario.

Resumo Contexto A bomba injetora é o método padrão-ouro para a injeção de contraste em aortografias. Entretanto, é uma ferramenta de alto custo, o que limita o seu uso. A injeção manual surge como alternativa, mas a pressão gerada com esse método é baixa, e, por isso, a qualidade das imagens não é usualmente satisfatória. Assim, a criação de um método de baixo custo capaz de gerar imagens de qualidade é imperativo. Objetivos Comparar os parâmetros de injeção de um novo dispositivo mecânico (manivela articulada) criado em um hospital universitário com os parâmetros da injeção manual e com os valores ideais da bomba injetora. Métodos Um simulador do território aórtico foi construído, e parâmetros de injeção entre os diferentes métodos em um cenário laboratorial controlado foram analisados. O teste t de Student e o teste de Mann-Whitney foram usados para análise estatística. Três residentes de Cirurgia Vascular realizaram os testes (nove usando o novo dispositivo, e nove usando a injeção manual, totalizando 54 injeções). Resultados Houve diferença estatisticamente significativa (p < 0,05) entre os dois métodos, considerando os parâmetros: variação de pressão, pressão máxima, tempo de injeção, tempo até a pressão máxima e volume até a pressão máxima. Conclusões A manivela articulada atingiu níveis superiores de pressão e de velocidade de injeção, com menor tempo de injeção do que a injeção manual. É um dispositivo simples, de baixo custo e com resultados comparáveis à bomba injetora, o que sugere seu uso potencial na geração de imagens satisfatórias em aortografias.

Protocolo de prueba de ventilador mecánico para atención de pacientes con COVID-19 en modelo porcino / Mechanical ventilator test protocol for care of patients with COVID-19 in porcine model

RESUMEN A raíz de la pandemia generada por el SARS-CoV-2, los sistemas de salud de los distintos países han experimentado un dramático aumento en la ocupación de las unidades de cuidado intensivo y, por ende, una alta demanda de ventiladores mecánicos. En este artículo se propone un protocolo de pruebas de ventiladores mecánicos de bajo costo en modelos porcinos, como parte del desarrollo de equipos biomédicos que pueden apoyar la crisis sanitaria suscitada por la pandemia. El protocolo aborda aspectos que incluyen la fase previa a la prueba, el manejo anestésico, de vía aérea, seguimiento de laboratorio, recuperación y seguimiento del animal. Como resultado, se presenta a la comunidad académica un protocolo de validación de prototipo de ventilador mecánico en espécimen porcino como un referente para su aplicación y revalidación por parte de grupos interesados en el desarrollo de tecnologías locales de bajo costo.

ABSTRACT As a result of the SARS-CoV-2 pandemic, health systems globally have seen a dramatic increase in the occupancy of intensive care units, with mechanical ventilators being a resource in high demand in the care of these patients. This article proposes a protocol for testing low-cost mechanical ventilators in pig models, as part of the development of locally manufactured biomedical equipment that can support the health crisis caused by the pandemic. The protocol addresses aspects that include the pre-test phase, anesthetic and airway management, laboratory monitoring, recovery and monitoring of the animal. This document presents to the academic community a validation protocol of a mechanical ventilator prototype in a pig specimen that can be a reference for its application and revalidation by other groups interested in the development of local and low-cost technologies.

Eficacia de la Litotripsia Extracorpórea por Ondas de Choque en el tratamiento de litiasis renal en el Servicio de Endourología del Hospital José Carrasco Arteaga. Bienio 2015-2016 / Efficacy of Extracorporeal Shock Wave Therapy as a treatment for nephrolithiasis at the Endourology Service of Hospital Jose Carrasco Arteaga. Biennium 2015-2016.

INTRODUCCIÓN: La litiasis renal es la tercera patología urológica más frecuente, después de las infecciones y la patología prostática. Una de las opciones de tratamiento es la litotripsia extracorpórea por ondas de choque (LEOCH); se trata de una técnica mínimamente invasiva, de fácil repetición, efectiva, de baja morbilidad y bajo costo. El objetivo del presente estudio fue mostrar la eficacia de la LEOCH en el tratamiento de litiasis renal y su asociación con diferentes factores. MATERIALES Y MÉTODOS: Se realizó un estudio descriptivo, observacional, de corte transversal, con datos retrospectivos, con pacientes diagnosticados de litiasis renal, que recibieron tratamiento con LEOCH en el Servicio de Endourología del Hospital José Carrasco Arteaga, durante los años 2015 y 2016. La muestra fue de 146 pacientes. La información se obtuvo de las historias clínicas de los pacientes. Para el análisis, se empleó el programa SPSS v19.0. Los resultados se mostraron a través de frecuencias y porcentajes en tablas, se aplicó Chi cuadrado para medir la asociación entre las variables. RESULTADOS: La ubicación de los litos fue principalmente intrarenal y del lado izquierdo. El tamaño medio de los cálculos fue de 12.66 mm y la densidad media de 996.97UI. Al control tomográfico posterior a la LEOCH, en el 22.6% de los pacientes se destruyó totalmente el lito y en casi un tercio de los pacientes no se apreciaron cambios. Luego de la LEOCH, la mayoría de los pacientes recibieron tratamiento expulsivo. 97% de los pacientes no tuvieron complicaciones. CONCLUSIÓN: La efectividad de la LEOCH disminuyó con la edad, en las mujeres resultó igualmente menos eficaz, aunque las diferencias no fueron significativas. La ubicación del lito, así como su tamaño resultaron tener asociación estadísticamente significativa con la efectividad del tratamiento; los litos ureterales y pequeños se destruyeron completamente con mayor frecuencia que los renales y de gran tamaño. La densidad no mostró relación significativa con la efectividad de la LEOCH.

BACKGROUND: nephrolithiasis is the third most common urological pathology, followed by infections and prostatic pathologies. One of the treatment options is extracorporeal shock wave therapy (ESWT); it is a minimally invasive technique, easy to repeat, effective, with low morbidity and low cost. The aim of this study was to demonstrate the effectiveness of ESWT as a treatment for nephrolithiasis and its association with some factors. METHODS: We carried out a descriptive, observational, cross-sectional study with retrospective data, with patients diagnosed of nephrolithiasis and treated with ESWT at the Endourology Service of Hospital José Carrasco Arteaga, during the years 2015 and 2016. The sample was constituted of 146 patients. Data was Results are shown with frequencies and percentages in charts, Chi square was applied to measure the association between variables. RESULTS: The location of the stones was mainly intrarenal and on the left side. The mean size of the stones was 12.66 mm and the mean density was 996.97IU. After ESWT, tomographic control reported complete destruction of the stone in 22.6% of the patients and in almost a third of the patients there were no changes. After ESWL, most of the patients received expulsive treatment. 97% of the patients had no complications. CONCLUSION: The effectiveness of ESWL decreased with age, also it was less effective in women, but the association was not statistically significant. The location of the stone, and its size had statistically significant association with the effectiveness of the treatment; ureteral and small stones were completely destroyed more frequently than renal and big stones. The stone density had no association with LEOCH effectiveness.

Low cost simulator for cardiopulmonary unobstructed and reunion procedures in infants / Simulador de baixo custo para procedimentos de desengasgo e reanimação cardiopulmonar em lactentes

INTRODUCTION: The use of realistic simulation methodology is used in several learning scenarios, allowing students to participate directly in the problematization of situations that require immediate professional action. OBJECTIVE: To develop, validate and validate a low cost simulator for cardiopulmonary resuscitation and resuscitation procedures in infants. METHODS: An experimental study carried out with undergraduate students of the 1st year of the Nursing course at a higher education institution in the State of Paraíba, developed a simulator model with dimensions similar to an infant with low cost materials and made possible the use as a prototype for Basic Life Support training. The prototype was developed with the accessories for disengagement and cardiopulmonary resuscitation maneuvers. The data collection instrument was a questionnaire based on the American Hearth Association Basic Life Support guideline to enable and validate the Basic Life Support training instrument. RESULTS: The low-cost prototype for Basic Life Support training was used as a learning object adequately and enabled the teaching-learning process as an accessible resource at low cost. Based on the questionnaire applied, we observed that there was an increase in the median number of correct answers and a reduction in the median of errors, which indicated an improvement in the acquisition of information and improvement in learning, observed through the test of Signal of Related Samples and the test of the Signs of Wilcoxon, (MA) and errors (ME), before and after training where it was found that there was an increase in MA and a reduction in ME with 5% significance (p <0.001). The frequencies of response modifications after training with the simulator were also studied by means of the two-tailed McNemar test where Q1, Q2, Q3, Q4, Q8, Q9, Q13 and Q15 questions showed significant changes (p <0, 05). CONCLUSION: A prototype was developed that simulated the training activity in Basic Life Support, which made it possible to carry out the procedures appropriately in positioning and simulation of cardiac resuscitation, mouth / nose ventilation, and tapping in the scapular region. Which allowed the validation of disengagement and resuscitation training as a low cost alternative for health education.

INTRODUÇÃO: O uso da metodologia de simulação realística é utilizado em diversos cenários de aprendizado, permitindo aos discentes a participação direta na problematização de situações que requerem ação profissional imediata. OBJETIVO: Desenvolver, viabilizar e validar um simulador de baixo custo para procedimentos de desengasgo e reanimação cardiopulmonar em lactentes. MÉTODO: Estudo experimental realizado com alunos de graduação do 1° ano do curso de Enfermagem em uma instituição de ensino superior do Estado da Paraíba, foi desenvolvido um modelo simulador com dimensões similares a um lactente com materiais de baixo custo e acessórios para manobras de desengasgo e reanimação cardiopulmonar, viabilizado o uso como protótipo para treinamento de Suporte Básico de Vida. O instrumento de coleta de dados foi o questionário baseado no guideline do Suporte Básico de Vida da American Hearth Association. RESULTADOS: O protótipo para treinamento em Suporte Básico de Vida foi utilizado como adequadamente e viabiliza o processo ensino-aprendizagem como recurso acessível de baixo custo. O questionário aplicado observamos que houve incremento na mediana de acertos e redução na mediana de erros e indicou melhora na aquisição de informações e aprendizado, através do teste de Sinal de Amostras Relacionadas e o teste dos Postos Sinalizados de Wilcoxon, as medianas de acertos (MA) e erros (ME), antes e depois do treinamento, com o aumento de MA e redução em ME com 5% de significância (p<0,001). As respostas as questões Q1, Q2, Q3, Q4, Q8, Q9, Q13 e Q15 mostraram modificações significativas (p<0,05), após o treinamento com o simulador por meio do Jteste de McNemar bicaudal ao estudar as frequências de modificações de respostas. CONCLUSÃO: O protótipo obteve sua aplicação em simulação de atividade de treinamento em Suporte Básico de Vida, viabilizou a realização dos procedimentos da forma adequada em posicionamento e simulação de reanimação cardíaca, ventilação boca/nariz e tapotagem na região escapular, permitiu validar o treinamento de desengasgo e reanimação como uma alternativa de baixo custo para educação em saúde.

O oftalmologista e as uvas: Um modelo de treinamento microcirúrgico / The ophthalmologist and the grapes: A microsurgical training model

Resumo Objetivo: Desenvolver um modelo de treinamento de cirurgias corneanas utilizando uvas. Métodos: Foram empregadas uvas como estruturas que mimetizam o tamanho do globo ocular humano, recobertas com materiais de látex, simulando a pratica de cirurgias de córnea utilizando um sistema de videomagnificação. Foram realizados oito pontos simples. Foi avaliado o tempo de confecção do procedimento. Resultados: Foram realizadas 25 simulações como o modelo descrito. O tempo médio de realização da rafia foi de 34,56 ±5,79 minutos. A análise da correlação entre o tempo e a ordem das cirurgias mostrou uma redução no tempo de confecção. Conclusão: O modelo de treinamento oftalmológico utilizando uvas mostrou-se capaz de simular as etapas básicas do treinamento de suturas microcirúrgicas.

Abstract Objective: Develop a training model for corneal surgery using grapes. Methods: Grapes were used as structures that mimic the size of the human eyeball, covered with latex materials, simulating the practice of corneal surgery using a videomagnification system. Eight simple stitches were performed. The surgical time was evaluated. Results: 25 simulations were carried out as the model described. The mean time taken for the raffia was 34.56 ± 5.79 minutes. The analysis of the correlation between the time and the order of the surgeries showed a reduction in the confection time. Conclusion: The ophthalmic training model using grapes proved to be capable of simulating the basic stages of microsurgery suture training.

Desarrollo de modelos educativos para el aprendizaje de nuevas técnicas endoscópicas: miotomía endoscópica por vía oral (POEM) y elastografía por ultrasonido endoscópico / Educational models for learning Peroral Endoscopic Myotomy (POEM) and Endoscopic Ultrasound Elastography

Resumen Objetivos: presentar el desarrollo de modelos educativos para el aprendizaje de dos técnicas endoscópicas vigentes, ampliamente difundidas y de gran implicación clínica, con la única intención de permitir la adquisición de destrezas básicas y avanzadas a residentes y gastroenterólogos. Materiales y métodos: se idearon dos modelos sencillos, de muy bajo costo, fácilmente reproducibles y reutilizables, con los cuales se logra ejecutar la totalidad de los procedimientos descritos. Además, permiten al operador integrar el desarrollo de habilidades y la adquisición de los conceptos teóricos mínimos requeridos, sin las presiones generadas por el riesgo existente de complicaciones. Resultados: la tendencia actual a nivel mundial se conduce hacia el desarrollo de modelos de enseñanza que aceleren la curva de aprendizaje, así como de procedimientos altamente exigentes y asociados a complicaciones potencialmente graves. Con estos modelos es posible poner a prueba al endoscopista, mediante una evaluación continua y supervisada. Su implementación en unidades de gastroenterología es sencilla, sin la necesidad de una inversión superlativa o el desplazamiento a otros países. Conclusiones: se trata de un gran aporte al desarrollo científico y educativo de nuestro país, ya que la creación y la implementación de nuevas técnicas endoscópicas y su aprendizaje no deben ser asumidos por los pacientes. En este punto, estamos de acuerdo con los conceptos emitidos por diferentes asociaciones médicas respecto a que los cursos teórico-prácticos de corta duración -y en algunas ocasiones virtuales- no constituyen una formación mínima, requerida para lograr la acreditación.

Abstract Objectives: This article presents the development of educational models for learning two widespread recent endoscopic techniques which have great clinical implications. Its sole intention is to allow acquisition of basic and advanced skills by residents and gastroenterologists. Materials and methods: Two simple, very low cost, easily reproducible and reusable models were devised. Procedures are fully described in ways that allow the operator to integrate the development of skills and acquisition of the minimum theoretical concepts required without the pressures generated by risks of complications. Results: The current global trend is to develop teaching models that accelerate the learning curve for highly demanding procedures that are associated with potentially serious complications. With these models it is possible to test endoscopists through continuous supervised evaluations. Implementation by gastroenterology units can be done easily without the need for large investments or travel to other countries. Conclusions: This is a great contribution to the scientific and educational development of Colombia since neither development of new endoscopic techniques nor the process of learning how to perform them should put patients at risk. We agree with the ideas of numerous medical associations regarding theoretical-practical courses of short duration even though some virtual sessions, "do not constitute the minimum training required needed for accreditation".